Researchers in London, Ontario, are conducting a first-ever clinical trial to determine which treatment option gives patients with throat cancers the best quality of life. These cancers are dramatically on the rise due to the epidemic of HPV (human papilloma virus) infection.

Surgeon Dr Anthony Nichols and radiation oncologist Dr David Palma at the Lawson Health Research Institute have received a $223,000 Quality of Life Grant from the Canadian Cancer Society to conduct the study. Dr Nichols is an assistant professor in head and neck surgery at Western University. Dr Palma is a clinician-scientist with the Ontario Institute for Cancer Research.

The current standard treatment for throat cancers is radiation and chemotherapy, which results in good control of the disease but can leave patients with a variety of life-changing side effects, such as problems with speaking, swallowing, tasting and hearing and even feeding tube dependence.

A minimally invasive robotic surgery has emerged as a promising alternative treatment that appears to have fewer side effects.

“Patients with HPV-related throat cancers tend to be younger and healthier and have a good chance of being cured. As they will have to live with the side effects of treatment for decades, post-treatment quality of life is of paramount importance,” says Dr Nichols.

“Before we can adopt a new treatment, we have to prove that the rates of cure are as good as they are with the standard treatment, which is chemotherapy with radiation,” says Dr. Palma. “Sometimes new technologies are introduced with a lot of hype but don’t prove to be helpful in the end. Transoral robotic surgery has shown tremendous promise as a treatment option, and we are the only ones in the world doing this type of study right now.”

For the 3-year study, patients with early stage cancer of the oropharynx (which includes the tongue, soft palate, side and back walls of the throat, and tonsils) are invited to participate in a randomized phase II clinical trial. Patients will be assigned to receive either the current standard treatment (radiation, plus or minus chemotherapy) or the robotic surgery. One year after treatment, patient quality of life will be assessed for side effects.

This will be the first clinical trial to directly compare the 2 treatment methods and has the potential to have an international impact on the treatment of patients with throat cancers. In the United States, the robotic surgery is already being used for these types of cancers despite the lack of high-level evidence to support it.

To do the surgery, doctors use tiny robotically controlled surgical implements to remove tumours of the tongue, tonsils, palate or throat. The robot has a viewfinder and 3-D camera that can see around corners, and the tiny robotic arms can get into tight spaces where the surgeon’s hands cannot fit. While the surgeon watches what’s happening on a screen, the robotic arms precisely mimic the movements of the surgeon’s hands and can even filter out the surgeon’s hand tremor.

“The Canadian Cancer Society knows how important a patient’s quality of life is during and after cancer treatment,” says Dr Siân Bevan, Director of Research at the Canadian Cancer Society. “This exciting new surgical method shows great promise to vastly improve quality of life, and we are happy to be able to fund this important study, with the generous support of our donors.”

About HPV and cancer

According to Dr. Nichols, HPV is the most common sexually transmitted infection. “The incidence of throat cancers has increased dramatically in recent years due in large part to widespread infection with HPV.The increase is thought to be because of changes in sexual practices that began in the 1960s.”

These cancers typically take more than 20 years to develop. Some strains of the HPV virus cause cervical cancer as well as ano-genital cancers. More recently, HPV infections have been found to cause cancers of the oropharynx.

It is estimated that 75% of sexually-active Canadians will have at least one HPV infection in their lifetime. The body’s immune system usually gets rid of an HPV infection on its own. Most HPV infections (about 70%) go away without any treatment within 1–2 years. Persistent infection with high-risk HPV types over many years can cause precancerous changes and cancer.

HPV infection is associated with about:

25%–35% of oropharyngeal cancers

40% of vaginal and vulvar cancers

40%–50% of penile cancers

80%–90% of anal cancers

Dr Nichols says that throat cancer patients whose disease was caused by an HPV infection tend to be diagnosed in their 40s and 50s, as opposed to patients whose throat cancer was caused by smoking and alcohol (these patients tend to be diagnosed at 60 or older).

A vaccine is available in Canada to prevent HPV infection. It protects against the types of HPV that cause 70% of HPV-related cancers. For more information, visit cancer.ca.

Other Quality of Life Grants

Dr Kim Edelstein, Toronto, $299,754 – Since cancer in young adults occurs during crucial formative years, it can have a particularly devastating effect, leaving survivors with a variety of long-term side-effects as a result of the disease and treatment. In her study, Dr Edelstein is exploring the impact of chemotherapy on thinking abilities during the first year after being diagnosed with cancer and whether these changes impact psychosocial development, with the findings to be used to develop strategies to help prevent or decrease these problems.

Dr Stephen Hall, Kingston, $153,029 – Using a series of questionnaires delivered over a 3-year period, Dr Hall will lead the first study of its kind to examine how patients who have had head and neck cancer perceive follow-up appointments to understand their attitudes, needs, fears and expected benefits about the appointments. His goal is to improve the quality of life for survivors by making the follow-up care more effective for individual patients while improving the efficiency of the health care system.

Dr Robert Klaassen, Ottawa, $177,794 – Using a survey developed with the input of patients, caregivers, health care providers and quality of life experts, Dr Klaassen aims to assess the impact of treatments on the quality of life of patients with incurable blood disorders that put them at a high risk of developing cancer. Because of the incurable nature of the conditions – named myelodysplastic syndromes – determining the impact of treatment on quality of life is crucial and this survey may become a critical resource and powerful tool to achieve this.

Dr Andrew Matthew, Toronto, $137,233 – Sexual dysfunction after prostate cancer surgery is one of the most substantial concerns for patients and their partners and has a significant impact on quality of life. To address this important health issue, Dr Matthew is developing a biomedical-psychosocial intervention which incorporates the active participation of the partner and features medical, psychological and social methods, with the eventual goal of introducing a new and effective way to support intimacy and optimal sexual health.

Dr Roanne Thomas, Ottawa, $244,128 – Using a variety of methods, including group discussion, photography, journaling and film, Dr Thomas will document the breast cancer experiences of First Nations, Inuit and Metis women. Since little is known about the factors which affect the breast cancer experiences of these groups of women, Dr Thomas’ study will address gaps in knowledge and care to uncover valuable information for the development of future support programs and education materials for health professionals

About the Quality of Life Grants

This program has been created to support quality of life cancer research that has the potential to make a significant impact on the burden of disease in patients, survivors and caregivers.

For 75 years the Canadian Cancer Society has been with Canadians in the fight for life. We have been relentless in our commitment to prevent cancer, fund research and support Canadians touched by cancer. From this foundation, we will work with Canadians to change cancer forever so fewer Canadians are diagnosed with the disease and more survive.